Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients

World J Gastroenterol. 2019 Mar 14;25(10):1266-1277. doi: 10.3748/wjg.v25.i10.1266.


Background: Asymptomatic children with Crohn's disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.

Aim: In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.

Methods: In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.

Results: 53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).

Conclusion: Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

Keywords: Biomarker; Children; Crohn’s disease; Disease relapse; Fecal calprotectin.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Asymptomatic Diseases / therapy
  • Biomarkers / analysis
  • Child
  • Crohn Disease / diagnosis*
  • Crohn Disease / drug therapy
  • Feces / chemistry*
  • Female
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Infliximab / therapeutic use
  • Leukocyte L1 Antigen Complex / analysis*
  • Longitudinal Studies
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Recurrence
  • Symptom Flare Up


  • Biomarkers
  • Gastrointestinal Agents
  • Leukocyte L1 Antigen Complex
  • Infliximab

Supplementary concepts

  • Pediatric Crohn's disease